County OKs Jail Reforms

After a six-year federal probe of psychiatric care in the Los Angeles County jails, county officials have agreed to broad reforms aimed at better identifying and treating thousands of mentally ill inmates.

The agreement, which avoids a potential civil rights lawsuit by the U.S. Department of Justice, follows years of alleged abuses in the nation’s largest jail system, including excessive force and improper use of restraints that led to the deaths of at least two mentally disturbed inmates.

Under the terms of the accord, the county agreed to new standards governing virtually every stage of care for the estimated 2,500 mentally ill inmates who populate the jail on any given day, from intake screening and diagnosis to drug treatment, suicide prevention and medical record-keeping.

Los Angeles County Sheriff Lee Baca, whose department runs the jail system, said the long negotiations with federal officials have already produced important changes.

Since the investigation began in 1996, the Sheriff’s Department has moved mentally ill inmates into modern facilities at the Twin Towers jail and launched a computerized system to track their medical records. The county Department of Mental Health, which oversees inmate psychiatric care, has doubled its jailhouse staff.

“The system we’ve developed is far more effective in providing proper services and making sure that people, when they get out of jail, don’t come back because of their mental health problems,” Baca said. He said the Justice Department “has been a positive partner in helping us write our own future.”

Steven H. Rosenbaum, chief of the Justice Department’s Special Litigation Section, said the federal government will continue to monitor mental health conditions in the county jails.

“The county has made substantial improvements in its treatment of inmates with mental illness. There’s still more work to be done,” he said.

L.A. County jails hold about 20,000 inmates who are serving short terms for misdemeanors or awaiting trial on felony charges.

Officials estimate that at least one-tenth of the inmates have diagnosed mental illness, making Twin Towers the largest mental-health housing facility in the nation, Baca said.

Six years ago, when Justice Department lawyers toured the jail system with a team of mental health experts, they found mentally ill inmates crammed into dark, dirty cells with virtually no contact with staff psychiatrists. The inmates were rarely let out for recreation, or even for showers. Medical records throughout the sprawling nine-jail system were kept on paper, sometimes illegibly, leading to frequent lapses in care. Some ailing inmates went for weeks without the psychotropic medications they needed, and others were given medicine they didn’t need.

“We observed cell after cell crowded with inmates who were psychotic or severely depressed and getting worse,” a 1997 Justice Department report said. The situation was so bad, federal officials concluded, that the county was violating the inmates’ constitutional rights.

Under the threat of a lawsuit, county officials began devoting more attention and money to the problem. The county now spends more than $20 million a year on jailhouse mental health care, according to the county’s chief administrative officer.

“This has been a long, hard haul,” said Merrick Bobb, a special counsel to the Board of Supervisors who has monitored the Sheriff’s Department for 10 years. “There was a focused effort by the Sheriff’s Department to overcome those problems and to allocate the necessary resources and staff.”

Bobb has issued several reports in recent years that highlight the failings of jailhouse medical and mental health care. Though some improvements have been made, his reports note that the Sheriff’s Department has repeatedly ignored recommendations for reform.

The Department of Justice agreement, made final Dec. 19, requires the county to conduct mental health screenings of all new inmates. Trained mental health workers will devise comprehensive treatment plans for mentally ill inmates, and no inmate will be locked down for more than 19 hours per day. Psychotropic medicines are to be properly prescribed and documented, and suicidal inmates placed in a safe setting and promptly evaluated.

Some observers remain skeptical. Stephen Yagman, a civil rights lawyer who has represented many mentally ill inmates, said Los Angeles County has long resisted efforts to reform its jails.

“An agreement ... is actually worse than no agreement at all, because it creates an illusion that what is set forth in the agreement is actually going to be done,” Yagman said.

Occasionally, the county’s frayed system turns downright dangerous. In the midst of the federal investigation in 1999, a schizophrenic homeless man named Kevin Evans was stopped by sheriff’s deputies in the Antelope Valley for unlawful possession of a shopping cart and taken to the Twin Towers jail near downtown Los Angeles. Hours later, he was dead.

Evans, 33, died of cardiac arrest after a swarm of deputies tried to restrain him when he put up a fight as a deputy took away his sandwich. A coroner’s autopsy found that Evans, who had severe heart disease, had neck bruises and “clear evidence of recent throat trauma,” which might have contributed to asphyxiation as he struggled with the deputies.

A year earlier, another mentally ill inmate died of a heart attack after a fight with deputies. The coroner’s office ruled that death a homicide.

The Bobb report on the Evans case found that the Sheriff’s Department violated its own policies and “acted in a negligent, even perhaps reckless, way.”

The Evans case highlighted the gloomy loop many homeless and sick people travel between the cellblock and the streets. California released patients from state mental hospitals beginning in the 1960s, but the state has failed to adequately expand community-based treatment programs, leaving many sick people with nowhere to turn.

“The core problem is that the L.A. County Jail has become the psychiatric facility of last resort for people who should not be in the criminal justice system,” said Ben Wizner, an attorney for the American Civil Liberties Union of Southern California, which has monitored conditions in the county jails since the 1970s. “People end up cycling through the system because there aren’t enough mental health facilities to care for them. The Sheriff’s Department is kind of the end of the line.”

To help break the cycle, Baca and others have pushed for state funding to upgrade the Salvation Army shelter in Bell. Soon, he said, he will have 250 beds available there for mentally ill homeless people like Kevin Evans.

“My theory is that, hey, a guy steals a shopping cart. Why don’t we just get a nonprofit group to give him one? There are other ways to solve these problems than putting someone in jail,” Baca said. “My belief is that jails are not mental health hospitals for the low-level offender.”